HomeMy WebLinkAbout24-584 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
❑ ❑ RESULTED ❑ CASE z4-ss4 2
INTERSTATE CITY STREET FIRE
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFH1C;l F ❑ LOCAL AOENC 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION 01 - 1-- 2024 1420 17 ❑. S 8 W Li OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S CARR RD BLOCK NO. e✓ 10700
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 20 00 FMILES N EET e S ❑ E e 108THAVESE
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:4257537156 0 81
30
6� LAST NAME NGARACHU FIRSTNAME DUNCAN MIDDLE K 1 1 2 31
INITIAL
STREET Z126418110THPLSE CITY KENT ST WA ZIP 98030 2
NEW ADDRESS '
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED II
INTERLOCK YES NO,/ INTERLOCK YES NOF,/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU SE CLASS 1 NATURE OF INJURIES 2❑
3
10❑ Pi aT�S� 638YST sTATe WA VIN# 5FNYF48479B035536
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 3 5 VIN#' VIN#'
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 9 9 34
13 2 2009 HOND PILOT SW DAMAGE YES No YES[:] No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO STATE FARM 1276407-801.47F 3 4
IN EFFECT &POLICY# 9TOP
15❑ LE
vEGALLv HICLE 5 36
YES�No D CITATION# 4A0131297 CHARGE FOLLOW VEHICLE TOO CLOSELY 10 Borrom
STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES,/ NO D:2815151408
16 a
LAST NAME ARELLANO FIRST NAME POMBO MIDDLE R
INITIAL
17❑ STREET - 706 5TH AVE S CITY KENT ST WA ZIP 98032 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCK YES❑No� INTERLOCK YEs❑NOF YES
❑NOF,/
19 DIVER #
INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE BRX6997 TATe WA VIN# KNADE243496539974
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2009 MAKE KIA MODEL RIO STYLE HB VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO OMAR MIRANDA 7065TH AVE S KENT WA 98032 D:3467109958 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 1 GD
LGALLY
EHI�LEYES❑,/ NuCITATION# 4AO131298 CHARGE OP MOT VEH W/OUT INSURANCE
25 s � a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
R.ON/SHl 5738 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE41505
COLLISION REPORT III III III III III 111
1591972 CASE# 24-584
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(LAST FIRST,MIDDLE INITIAL)_
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D D B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Unit 2 and unit 1 both facing eastbound on S Carr Rd at 108th Ave SE, stopped for traffic signal. Unit
2 is first in line of stopped cars, with unit 1 directly behind. When light changes, unit 1 accelerates.
Unit 2 does not, and unit 1 strikes unit 2 from behind. Driver 1 Ngarachu said that unit 2 slid
backwards on wet pavement, into the front of unit 1. Driver 2 Arellano denies having slid backwards.
Traffic camera video shows that unit 2 slipped backwards for about 6 inches; unit 1's acceleration
caused unit 1 to close about 5 feet into the back of unit 2. Driver 2 Arellano and car's owner Omar
Miranda told me that Miranda had recently purchased the car, and had not yet insured it.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
R.ONISHI 01-17-24 05:08 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 1 111812024 4:14:22 AM
BADGE OR ID# 5738 OR]# ! WA0171300 TIME POLICE DISPATCHED; 3:07 Pry] TIME POLICE ARRIVED f 3:10 PM
PART I PAGE IT]OF 3�
REPORT NO. EE41505 CASE# ' 24-584 DATE AND TIME 01/17/24 14:20
OF COLLISION
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